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Psychiatry > Pharmacology for mood disorders > Flashcards

Pharmacology for mood disorders Flashcards

1
Q

What are indications for antidepressants

A 
depressive illness (moderate-severe or chronic mild) 
anxiety disorders
neirpathic pain 
insomnia 
bulemia 
migraines 
IBS
narcolepsy 
ME
impulsivity
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2
Q

what is the neurropharmacology of antidepressants

A

generally increase the neurotransmission of seratonin or noradrenaline

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3
Q

how long do antidepressants take to work

A

1-6 weeks

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4
Q

examples of SSRIs

A 
sertraline
fluoxetine
citalopram
paroxetine
escitalopram
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5
Q

what are the best tolerated antidepressants

A

SSRIs

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6
Q

common SSRI side effects

A

nausea

anxiety exacerbation

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7
Q

SSRI side effects

A 
insomnia
apathy/fatigue
diarrhoea 
dizziness
restlessness
sexual dysfunction
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8
Q

which antidepressant is associated with teratogenicity and what does it do

A

paroxetine - cardiac dysfunction in the 1st trimester

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9
Q

what are the second most prescribed antidepressants

A

SNRIs

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10
Q

examples of SNRIs

A

venlafaxine

duloxetine

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11
Q

side effects of SNRIs

A

similar to SSRis

may be more sedative and has greater discontinuation symptoms

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12
Q

What are some bad parts about TCAs

A

tolerated poorly
Toxic in overdose

teratogenic

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13
Q

examples of TCAs

A 
amitryptaline 
clomipramine
lofepramine
imipramine
dosulepin
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14
Q

what are side effects of TCAs

A 
mainly antimuscarinic side effects: 
sedation 
hypotension 
dizziness
weight gain
Delerium 
constipation 
urinary retention 
dry mouth
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15
Q

How do MAOIs work

A

prevent metabolism of neurotransmitters

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16
Q

when are MAOIs typically used

A

usually only in atypical/treatment resistant depression

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17
Q

what food interactions do MAOIs have

A 
Foods high in tyramine:
aged wines
aged cheeses
cured/processed meats
beer
sourdough
liver
sauerkraut
soy products 
yeast extract
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18
Q

examples of MAOIs

A

phenelzine
tranylcypromine
isocarboxazid
moclobemide (reversible)

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19
Q

apart from food interactions - what side effects do MAOIs have

A 
dry mouth
nausea
change in bowel habt
sleep disturbance 
postural hypotension
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20
Q

what are examples noradrenergic/specific seratoninergic antidepressants

A

mirtazapine

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21
Q

what are some side effects to noradrenergic/specific seratoninergic antidepressants

A 
significant sedation 
weight gain 
appetite
drowsiness
dizziness
headache
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22
Q

how do noradrenergic/specific seratoninergic antidepressants compare to SSRIs

A

effective anti anxiety medication, and potentially superior to SSRIs in the treatment of depression

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23
Q

how long is required to wait until a treatment can be decided to be effective or not when medicating for depression

A

3-4 weeks (up to 12 in elderly)

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24
Q

what % of people respond to the first medication in mood disorders

A

70%

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25
Q

what do you do if there is a partial response in the 1st 4 weeks when using antidepressants

A

keep going for 2-4 more weeks

26
Q

how long do you treat for depression

A

6 months following resolution of symptoms

27
Q

what are typical withdrawal symptoms for SSRIs

A 
dizziness
N+V
numbness
tingling
headache
anxiety 
sweating 
sleep disturbance 
strange dreams 
shaking
electric shock-like symptoms
28
Q

what helps reduce withdrawal symptoms for SSRIs

A

tapering dose over 4 weeks (minimum) can help reduce symptoms

29
Q

what are indications for mood stabilisers

A

bipolar prophylaxis
acute mania/hypomania
bipolar depression
treatment-resistant depression with antidepressants

30
Q

how does the use of lithium affect suicide attempts

A

decreased by 80%

31
Q

what are the risks of lithium use

A

narrow therapeutic range - must be titrated and monitored closely

32
Q

common side effects of lithium

A 
tremor
polyuria
GI issues 
weight gain 
odema
polydipsia (thirst)
33
Q

what are the common causes of lithium toxicity

A

decreased sodium diet
dehydration
drug interaction (NSAIDS, ACE-i, Thiazide + loop diuretics)
illness

34
Q

What plasma concentration is a toxic dose for lithium

A

> 1.5mmol/L

35
Q

symptoms of lithium toxicity

A 
Diarrhoea
coarse tremor
ataxia
dysarthria (unclear articulation) 
nystagmus 
confusion
convulsions
36
Q

what plasma concentration of lithium is an indication for urgent haemodialysis

A

> 2.5mmol/L

37
Q

what is the monitoring program for lithium toxicity

A

lithium levels 1 every 3 months and after every dose change (1 week after, 12 hours after taking the dose)
U+E 1 every 6 months
TFT 1 every 6 months

38
Q

what teratogenicity does lithium cause

A

Ebstein’s anomaly - tricuspid is ineffective, and lower down into the right ventricle + an ASD (400x)

5x increased chance of overall cardiac defects

39
Q

how does sodium valproate work

A

Inhibits GABA breakdown, alters synaptic plasticity, promotes BDNF expression and Protein Kinase C levels

40
Q

what teratogenicity does Valproate exhibit

A

autism
neural tube defects
low verbal IQ
Congenital Malformation

41
Q

what are indications for lamotrigine

A

bipolar depression
bipolar prophylaxis
augmentation of antidepressants in depression

42
Q

indications for valproate

A

bipolar prophylaxis
acute mania
augmentation of antidepressants in depression

43
Q

why does valproate need to be titrated up

A

it causes steven-johnson syndrome (flu symptoms + rash)

44
Q

is lamotrigine teratogenic

A

yes but its the least teratogenic - it causes cleft lip palate in 1st trimester

45
Q

what are the indications for carbamazepine

A

bipolar depression
bipolar prophylaxis
acute mania/hypomania

46
Q

what’s the difference between lamotrigine and valoproate in the types of bipolar disorder they treat

A

lamotrigine - much better for bipolar depression

valproate - better at treating mania

47
Q

What are the indications for ECT

A

treatment-resistant depression
life-threatening severe depression
catatonia
treatment-resistant mania

48
Q

how long is ECT

A

course is 2x a week for 4-12 sessions

49
Q

what are the proposed mechanisms for ECT

A

Neurotransmitter modulation

changes in blood distribution in brain

modulation of neuronal connectivity

alteration of neuronal structures (hippocampal neurogenesis)

50
Q

contraindications for ECT

A 
cochlear implant 
raised ICP 
intracranial aneurysm 
cerebral hemorrhage 
DVT
recent MI 
decompensated congestive heart failure 
acute resp infection
51
Q

side effects for ECT

A 
anesthetic associated complications
headache
confusion 
impaired cognition 
temporary retro/anterograde amnesia 
long term - autobiographical memory impairment
52
Q

how severe are ECT side effects

A

usually mild and stop on completion of course

53
Q

how effective is ECT

A

very - 50-80% overall effectiveness, may even be up to 90% for treatment resistant depression

54
Q

how are the electrodes administered in ECT

A

bilateral - more effective, more side effects

unilateral - less effective, less side effects

55
Q

how does ECT work

A

seizure threshold is established using dose titration

56
Q

what is the risk of combining an SSRI with an NSAID, and what do you do to alleviate the risk

A

GI bleeding, PPI should be prescribed alongside

57
Q

what electrolyte disturbance are SSRIs associated with

A

hyponatremia

58
Q

what damage is associated with SSRI use in the 3rd trimester

A

persistent pulmonary hypertension

59
Q

what SSRI is preferred after an MI

A

Sertraline

60
Q

what regime should be used for tapering one SSRI into another one

A

reduce the dose of the original SSRI over 2 weeks, have a washout period of 4-7 days with no medication, then start the new one at the starting dose

Psychiatry (13 decks)

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